218060 Mortality disparities between geographic regions: Results from a risk percentiles model for coronary heart disease

Monday, November 8, 2010 : 11:11 AM - 11:29 AM

Christopher Stevenson, BSc (Hons) MSc PhD , School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Haider R. Mannan, BSC (hons) MSc MA MSc PhD , School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Anna Peeters, BSc (hons) PhD , School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Helen Walls, BSc MPH(hons) , School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Dianna Magliano, BAppSci(Hons) MPH PhD , Baker IDI Heart and Diabetes Institute, Caulfield, Australia
John J. McNeil, MBBS FRACP MSc FAFPHM PhD , School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Background: Planning of disease prevention strategies requires information regarding the distribution of absolute risk in the population to allow targeting of people at high disease risk. It is well known that death rates from coronary heart disease (CHD) are higher in remote areas of Australia compared with major cities. Less well understood is the distribution of the absolute risk of CHD death within the different geographic regions. We present a mathematical model of CHD which projects the lifetime risk of death among individuals in different percentiles of CHD risk. We apply this to model the distribution of CHD risk within different geographic regions. Methods: Using information from the Framingham1, MRFIT2 and AusDiab3 studies, the Australian population was divided into percentiles of CHD risk within age and gender groups by geographic location. Absolute mortality risk was determined at each percentile using current Australian mortality data. Survival curves were generated for each percentile using these risk estimates. Approximate confidence intervals were derived using bootstrap methods. Conclusions: The difference in life expectancy at age 25 between those in the lowest decile of CHD risk compared to the highest was 5.8 years (95%CI:4.7,6.7) in major cities compared to 8.5 years (95%CI:7.6,9.7) in remote areas. The difference in risk of premature death (before age 75) was 12% (95%CI:10%,14%) in major cities compared to 33% (95%CI:28%,38%) in remote areas. 1. Am. Heart J. 1991;121(1 Pt 2):293-298. 2. JAMA. 1982;248(12):1465-1477. 3. Diabetes Res. Clin. Pract. 2002;57(2):119-129.

Learning Areas:
Epidemiology
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe the differences in the distribution of coronary heart disease related risk between different Australian geographic regions.

Keywords: Health Disparities, Methodology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I oversee the program of research in epidemiological modelling in the Monash University School of Public Health and Preventive Medicine
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.